Ontario needs genuine health-system reform. Instead we get the Patients First Act. Doctors are hopping mad. So we are turning our backs on those who willfully ignore our warnings and our advice. They will now stand alone as their committees waste more time and taxpayer money on a sketchy health-care "transformation."

With our health care system facing ever-increasing demands and mounting budget constraints, we need to think differently about how we deliver health care. As we've seen in our series on change agents, this is precisely what change agents do -- they make a difference by doing things differently.

Whether it's a result of increased need, improved awareness or maybe both, millennials are asking for help in the form of access to mental health services that are often fragmented province to province and particularly difficult to access. Millennials are also most likely to be underinsured or have no insurance at all.

Today's disjointed pharmaceutical policy may be described as a Shakespearean tragedy -- a flawed system that will always end with demise. The relationship between health care policies, the funding of prescription drugs and public access to medically necessary medication is fragmented. It is in need of political leadership.

Transformational approach, holistic approach, social enterprise -- today it's become trendy to throw around buzzwords about social change. Fortunately, the buzzwords have a concrete meaning thanks to innovators in the not-for-profit world who implemented the approaches in the first place -- long before the jargon existed. These are the original change agents.

Many voting against the PSA argue that a fixed budget prevents physicians from providing necessary care to patients. No one is suggesting this. Patients who need care will be seen, necessary tests and surgeries will be done, family and specialist clinics will still see patients and physicians will continue to get paid to provide these services.

The OMA ramped up their aggressive endorsement: ads appeared on Facebook, Twitter and Instagram. Calls for a balanced discussion were met with threats from the OMA: "it's either the PSA or more cuts." Rules govern how such votes occur. The OMA's methods rigged the votes towards a "yes," seemingly breaching them all.

The reality is that Canada's present system is failing to live up to the principle of universality. By subsidizing hospital and doctor costs for all Canadians we have little public monies left over to help low- and middle-income Canadians pay for uninsured services and treatments.

Dread and despair, uncertainty and panic ebb and flow around thoughts of my medical career. Most days clamour with stories of clinics closing, physicians leaving and patients dying on waitlists -- all flatly ignored by provincial leaders. Some days, I even want to quit. After only sx years of independent practice, I'm burning out.

When you think of a not-for-profit organization, "change agent" probably isn't the first thing that comes to mind. But maybe it should be. Today, more and more not-for-profit organizations are not only making a difference, they are making it by doing things differently.

In case you think I'm asking you for more money for health care, I'm not. The $51 billion currently budgeted is enough, it just needs to be spent more efficiently. There will be significant immediate cost savings from cutting the bureaucratic bloats. But will this be enough to get you the election win you so badly desire in 2018?

Since I posted the letter that has spread further than I ever expected, I have received a few private responses on Facebook. They have all been touching and meaningful, and I appreciate everyone who has reached out to me. However it was today I received the most significant one.

The health care problems we face are not the result of insufficient spending. In fact, more money may be counterproductive. The primary focus of any new accord needs to be on the structure of the federal-provincial arrangements. The most commonly visualized instrument seems to be a return to something like the Health Accords of 2003 and 2004.

Biologic medicines constitute one of Canada's fastest-growing segments in pharmaceutical spending. For the year ending August 2014, biologics sales accounted for $5.6 billion or 24 per cent of the entire Canadian market for pharmaceuticals, and included four of the top five best-selling drugs in Canada.

It's no surprise that governments are focusing more attention on how to better support musculoskeletal (MSK) patients, considering that back pain is now the leading single cause of disability worldwide. Ontario chiropractors are playing a crucial role in the development of new models of care to help our province face these challenges.

Ontario physicians are well-paid. No one is arguing that. But right now, their paycheques are the only ones in the Liberal crosshairs. Let's look at other well-paid public sector employees. Google the Sunshine List; it's all laid out by name, occupation, and taxable income.

The acceleration of research and development of sophisticated biologic medicines and vaccines to more effectively prevent and treat disease has given rise to a form of healthcare known as personalized medicine.

Given all the growing research evidence on alternative therapies I wonder if our current medical system is old. Both the insurance companies and the government have not kept up with time. These services are scientifically studied to help, so is this truly a universal health care?

The percentage of long-term care home residents who are using antipsychotic medications varies from zero per cent in some of the province's homes to 67 per cent in others, according to a new report published by Health Quality Ontario. That's a striking amount of variation.

A health care system can remain public and universal all while allowing entrepreneurs to compete to provide services and attract clients, instead of leaving patients trapped in a public monopoly that fails to respond adequately to the demand for treatment. But first, we have to get over our fears concerning the role of the private sector in health care.

Yes, we do ration healthcare in America. It's just that those affected the most are those who have the least income. In America, we have become oddly blasé about income inequality and its consequences, increasingly willing to let those without simply do without. But the mere hint that a needs -- or evidence-based -- process might be used to allocate scarce or high-priced healthcare raises an outcry from those accustomed to getting what they want, when they want it.

Long waiting lists seem to have become a permanent feature of Canadian health care. But what are the effects of having to wait a long time for medical treatment? Is it just an annoyance, or are the consequences more serious?

The Liberal government's Health Accord recognized that‎; the Council of the Federation recognizes that; health care advocates and health professions recognize that. This is the mandate of the federal government and it is time to stop passing the buck to provinces.